The validity and reliability of an instrument to assess nursing competencies in spiritual care.

AIM: This study contributes to the development of a valid and reliable instrument, the spiritual care competence scale, as an instrument to assess nurses' competencies in providing spiritual care. BACKGROUND: Measuring these competencies and their development is important and the construction of a reliable and valid instrument is recommended in the literature. DESIGN: Survey. METHOD: The participants were students from Bachelor-level nursing schools in the Netherlands (n = 197) participating in a cross-sectional study. The items in the instrument were hypothesised from a competency profile regarding spiritual care. Construct validity was evaluated by factor analysis and internal consistency was estimated with Cronbach's alpha and the average inter-item correlation. In addition, the test-retest reliability of the instrument was determined at a two-week interval between baseline and follow-up (n = 109). RESULTS: The spiritual care competence scale comprises six spiritual-care-related nursing competencies. These domains were labelled: 1 assessment and implementation of spiritual care (Cronbach's alpha 0.82) 2 professionalisation and improving the quality of spiritual care (Cronbach's alpha 0.82) 3 personal support and patient counseling (Cronbach's alpha 0.81) 4 referral to professionals (Cronbach's alpha 0.79) 5 attitude towards the patient's spirituality (Cronbach's alpha 0.56) 6 communication (Cronbach's alpha 0.71). These subscales showed good homogeneity with average inter-item correlations >0.25 and a good test-retest reliability. CONCLUSION: This study conducted in a nursing-student population demonstrated valid and reliable scales for measuring spiritual care competencies. The psychometric quality of the instrument proved satisfactory. This study does have some methodological limitations that should be taken into account in any further development of the spiritual care competence scale. RELEVANCE TO CLINICAL PRACTICE: The spiritual care competence scale can be used to assess the areas in which nurses need to receive training in spiritual care and can be used to assess whether nurses have developed competencies in providing spiritual care.

Learning effects of thematic peer-review: a qualitative analysis of reflective journals on spiritual care.

This study describes the learning effects of thematic peer-review discussion groups (Hendriksen, 2000. Begeleid intervisie model, Collegiale advisering en probleemoplossing, Nelissen, Baarn.) on developing nursing students' competence in providing spiritual care. It also discusses the factors that might influence the learning process. The method of peer-review is a form of reflective learning based on the theory of experiential learning (Kolb, 1984. Experiential learning, Experience as the source of learning development. Englewoods Cliffs, New Jersey, Prentice Hill). It was part of an educational programme on spiritual care in nursing for third-year undergraduate nursing students from two nursing schools in the Netherlands. Reflective journals (n=203) kept by students throughout the peer-review process were analysed qualitatively The analysis shows that students reflect on spirituality in the context of personal experiences in nursing practice. In addition, they discuss the nursing process and organizational aspects of spiritual care. The results show that the first two phases in the experiential learning cycle appear prominently; these are 'inclusion of actual experience' and 'reflecting on this experience'. The phases of 'abstraction of experience' and 'experimenting with new behaviour' are less evident. We will discuss possible explanations for these findings according to factors related to education, the students and the tutors and make recommendations for follow-up research.

Determinants of quality management systems implementation in hospitals.

OBJECTIVE: To identify the problems and facilitating factors in the implementation of quality management system (QMS) in hospitals through a systematic review. METHOD: A search strategy was performed on the Medline database for articles written in English published between 1992 and early 2006. Using the thesaurus terms 'Total Quality Management' and 'Quality Assurance Health Care', combined with the term 'hospital' and 'implement*', we identified 533 publications. The screening process was based on empirical articles describing organization-wide QMS implementation. Fourteen empirical articles fulfilled the inclusion criteria and were reviewed in this paper. RESULTS: An organization culture emphasizing standards and values associated with affiliation, teamwork and innovation, assumption of change and risk taking, play as the key success factor in QMS implementation. This culture needs to be supported by sufficient technical competence to apply a scientific problem-solving approach. A clear distribution of QMS function within the organizational structure is more important than establishing a formal quality structure. In addition to management leadership, physician involvement also plays an important role in implementing QMS. CONCLUSIONS: Six supporting and limiting factors determining QMS implementation are identified in this review. These are the organization culture, design, leadership for quality, physician involvement, quality structure and technical competence.

The effectiveness of an educational programme for nursing students on developing competence in the provision of spiritual care.

AIM: To determine the effects of a course for nursing students on developing competence in spiritual care and the factors that might influence the effects. BACKGROUND: Studies suggest that role preparation in nursing for spiritual care is poor. For the assessment of competence, few or no explicit competency framework or assessment tools seemed to be used. DESIGN: Quasi-experimental crossover design (pre-post-test). METHOD: The subjects were students from Christian nursing schools in the Netherlands (n = 97). The intervention consisted of a course in spiritual care. Competencies were measured with an assessment tool, the Spiritual Care Competence Scale. Data were analysed by t-test procedures (paired-samples t-test). At T(1) vignettes were added to assess the quality of the students' own analyses. These data were analysed by a Mann-Whitney test. Regression analyses were performed on the influence of student characteristics on the subscales of the assessment tool. RESULTS: Ninety-seven students participated in this study. Analysis showed statistically significant changes in scores on three subscales of the Spiritual Care Competence Scale between groups (T(1)) and over time for the whole cohort of students on all subscales (T(2)). Clinical placement showed as a negative predictor for three subscales of the Spiritual Care Competence Scale. Experience in spiritual care and a holistic vision of nursing both showed as positive predictors on certain competencies. A statistically significant difference was observed between groups in the student analysis of a vignette with explicit spiritual content. CONCLUSIONS: The outcomes raise questions about the content of education in spiritual care, the measurement of competencies and the factors that influence competency development. RELEVANCE TO CLINICAL PRACTICE: The results provide nurse educators with insight into the effects of education in spiritual care on students' competencies and help them consider a systematic place for spiritual care within the nursing curriculum.

Aspects of spirituality concerning illness.

The spiritual dimension of illness, health and care may be seen as a unique aspect in addition to the physical, mental and social dimension. This contribution describes experiences of patients, nurses and hospital chaplains in relation to the spiritual aspects of being ill. Qualitative research was performed with the design of a focus group study, consisting of 13 focus groups with a total of 67 participants. A purposive sample was used comprising patients, nurses and hospital chaplains working in oncology, cardiology and neurology in different institutions and regions in the Netherlands. The qualitative analysis consisted of open coding and the determining of topics, followed by the subsequent attachment of substantial dimensions and characteristic fragments. Data were analysed by using the computer program KWALITAN. Spirituality play various roles in patients lives during their illness. There is a wide range of topics that may have an individual effect on patients. Despite differences in emphasis, the topics play a role in different patient categories. Although the spiritual topics seem to manifest themselves more clearly in long-term care relationships, they may also play a role during brief admittance periods (such as treatment decisions). The spiritual topics that arise from this study offer caregivers a framework for signalling the spiritual needs of patients. The question is not whether spirituality is a relevant focus area in care, but how and to what degree it plays a role with individual patients. Follow up research should aim at further exploration of spiritual aspects in care, the relationship between spirituality and health and at effective training of caregivers.

Evaluation of a transmural care model for multiple sclerosis patients.

This study assessed a transmural care model for multiple sclerosis (MS) patients to see whether it would improve patient outcomes, continuity of care, and quality of life. The study group consisted of 77 MS patients who received care on the basis of the Transmural Care Model for Multiple Sclerosis. A comparison group of 96 MS patients received traditional care as usual. A written questionnaire was sent to both groups of participants at baseline and 10 months later. The questionnaire focused on healthcare use and needs, continuity of care, and health-related quality of life. Few differences were found between the two groups. Active participation of and cooperation among healthcare professionals do not automatically lead to improved outcomes in MS patients.

Spiritual care: implications for nurses' professional responsibility.

AIM: This paper aimed to gain insight into the spiritual aspects of nursing care within the context of health care in the Netherlands and to provide recommendations for the development of care in this area and the promotion of the professional expertise of nurses. BACKGROUND: International nursing literature suggests that caregivers are expected to pay attention to spiritual aspects of patient care. In Dutch nursing literature, the spiritual dimension is increasingly becoming a focus of attention. Despite this, there is a lack of empirical data from professional practice in the Netherlands. METHOD: Data were collected by means of focus group interviews. The sample was made up of the specialist fields of cardiology, oncology and neurology and divided into groups of patients, nurses and hospital chaplains. The interviews took place between May and December 2004. Data were qualitatively analysed using the computer programme Kwalitan. RESULTS: Different spiritual themes emerged from the interviews. There were different expectations of the nurse's role with regard to spiritual aspects. The main themes derived from this research can be recognized as aspects of nursing competencies that are reported in the literature. However, the attention to spiritual aspects in the nursing process is not clear cut. It seems to be highly dependent on personal expression and personal commitment. CONCLUSIONS: The study raises questions about the nurse's professional role in spiritual care. The study shows that different factors (personal, cultural and educational) play a role in the fact that spiritual care is not structurally embedded in nursing care. Further research on the impact of that variable is recommended. RELEVANCE TO CLINICAL PRACTICE: Nursing care implies care for the spiritual needs of patients. To provide this care, nurses need to be knowledgeable regarding the content of spiritual care and the personal, professional, cultural and political factors influencing it. They also need to be able to participate in policy and decision-making discussions of spiritual care in clinical nursing practice.

Influence of socio-economic status, parents and peers on smoking behaviour of adolescents.

With the aim of analysing the importance of psycho-social factors in predicting adolescents' smoking behaviour, a model of the interrelations between socio-economic status, parents', peers' and adolescents' own smoking behaviours was tested. The sample consisted of 2,616 adolescents. LISREL analyses were used to support the model; males and females were evaluated separately. Peers' smoking is the strongest predictor of adolescent smoking. Parents' smoking behaviour influences adolescents' smoking directly, but also indirectly through the parents' influence on peers' smoking behaviour. Socio-economic status influences adolescent smoking indirectly through its influence on parents' and peers' smoking behaviour. Our model is significant in both males and females and explains 42-51% of the variance in adolescent smoking behaviour. Accentuation of peers' influence on adolescents' smoking behaviour without considering the interrelations between the influence of socio-economic status, parents and peers may lead us to incorrect conclusions in research as well as in prevention.

Socio-economic differences in health among Slovak adolescents.

OBJECTIVES: To explore socio-economic health differences among Slovak adolescents. METHODS: Socio-economic differences in health (psychological health: GHQ-12, vitality and mental health scale of RAND, experienced health complaints, chronic illness, use of medicines, self-reported health, self-perceived vulnerability to illness) were explored among Slovak adolescents (n = 2,616, 1,370 boys, 1,246 girls; mean age 15 years). RESULTS: Adolescents from lower socio-economic groups (parents' occupation, parents' education, type of school) experienced more health complaints; less frequently experienced their health as excellent or very good, more frequently reported to fall ill easier and less frequently use non-prescribed drugs in comparison with adolescents from higher socio-economic groups. Moreover, adolescents from lower occupational group of parents and lower type of school score significantly lower in mental health and in vitality and used prescribed drugs more frequently. We did not confirm any socio-economic differences in psychological health or prevalence of chronic illness. Our findings confirmed poorer health of girls in comparison to boys. There are no gender differences with regard to socio-economic differences in health. CONCLUSION: There are significant socio-economic health differences among Slovak adolescents.

Influence of social support on health among gender and socio-economic groups of adolescents.

BACKGROUND: The influence of social support on health was explored among gender and socio-economic groups with the aim of contributing to the explanation of socio-economic health differences among Slovak adolescents. METHODS: The sample consisted of 2616 Slovak adolescents (52.4% male, 47.6% female, mean age 15 years). The data were assessed by a self-reported questionnaire including measures of social support, socio-economic status and health. RESULTS: There are significant gender differences in social support, which are unfavourable for males. On the other hand, there are significant gender differences in health, unfavourable for females. Low social support is significantly related to worse health. There are significant socio-economic differences in both health and social support, which are unfavourable for lower socio-economic groups. Three groups, females, adolescents from lower socio-economic groups, and also adolescents reporting low social support, less frequently consider their health as excellent or very good. Females suffer from more health complaints, report worse psychological health, vitality and mental health in comparison to males, to adolescents from higher socio-economic groups, and to adolescents reporting high social support. Males and adolescents from lower socio-economic groups more frequently reported low social support in comparison to females and adolescents from higher socio-economic groups. No significant differences in the influence of social support on health among gender and socio-economic groups of adolescents were confirmed. CONCLUSION: Social support is related to health and it is unequally distributed among gender and socio-economic groups. Social support had a positive impact on health, but this effect was independent of gender and socio-economic groups.

Influence of health risk behavior and socio-economic status on health of Slovak adolescents.

AIM: To investigate the role of health risk behavior, such as smoking and alcohol consumption, in the explanation of socio-economic health differences among adolescents. The hypothesis of different exposure and the hypothesis of different vulnerability were explored. METHOD: In the study carried out in 1998, the prevalence of health complaints of smokers vs non-smokers, alcohol consumers vs abstainers, and among different socio-economic groups of 2,616 Slovak adolescents (mean age, 14.9-/+0.62 years) were investigated by means of self-reported questionnaires. The adolescents were stratified according to sex and type of secondary school. RESULTS: Socio-economic disadvantage and the presence of health risk behavior were associated with greater frequency of health complaints by adolescents. Prevalence of smokers was higher in lower socio-economic groups, but no such trend was found for the prevalence of alcohol consumers. Socio-economic status and health risk behavior interactively influenced health, when socio-economic status was assessed according to the mother's characteristics. Socio-economic health differences between non-smokers and abstainers were not significant, unlike the differences between the smokers and alcohol consumers. The influence of health risk behavior was weaker in higher socio-economic groups. CONCLUSION: Both hypotheses, of different exposure and different vulnerability, could explain socio-economic health differences among Slovak adolescents, with different exposure playing a more important role.

Socio-economic differences in health risk behaviour and attitudes towards health risk behaviour among Slovak adolescents.

OBJECTIVES: Socio-economic differences in the frequency of smoking, alcohol consumption, drug use, physical exercise, and attitudes toward smoking were explored in a sample of Slovak adolescents (1,370 boys, 1,246 girls, mean age 15 years). METHODS: Identification of socio-economic status was based on three indicators: the highest educational level of parents, the highest occupational class of parents, and the type of school the adolescents attended. RESULTS: Health risk behaviour was strongly related to socio-economic status based on all three socio-economic indicators, although there were some exceptions mostly related to education as indicator of socio-economic status and to alcohol consumption experience and drug use experience. The pattern of socio-economic differences was unfavourable for lower socio-economic groups of adolescents, except for differences in frequency of alcohol consumption among females when highest education of parents was used as an indicator of socio-economic status. CONCLUSIONS: There are socio-economic differences in health risk behaviour. Lower socio-economic groups of adolescents behave risky more frequently than higher socio-economic groups of adolescents.